Summary of Colorado’s Draft Proposed Regulation on Culturally Responsive Network
On November 30, 2021, the Colorado Division of Insurance (DOI), within the Department of Regulatory Agencies (DORA), released the draft proposed regulation establishing additional carrier requirements to ensure Colorado Option plans offer diverse, culturally responsive provider networks. The proposed network adequacy requirements, essential community provider standards, and network access plan requirements aim to reduce health disparities among enrollees and improve racial health equity, which are explicit goals of the Colorado Option. The regulation would take effect March 2, 2022.
Network Adequacy Requirements
Currently, carriers are required comply with network adequacy standards regarding service wait time, geographic access, and provider availability. Carriers offering the Colorado Option would be required to attest that the network is not narrower than the most restrictive network that the carrier is offering for non-standardized plans in the individual market for the metal tier for that rating area. Additional parameters include:
Demographic Data Collection – Carriers would be required to request network providers and their front office staff as well as plan enrollees to voluntarily submit demographic data – specifically, race and ethnicity, sexual orientation and gender identity, and ability status. To minimize the burden on network providers, carriers would include the request for demographic data in its request for data for the provider directory. Alternatively, carriers could obtain the demographic data through other available data sources. Provider demographic data would be included in network access plans filed with DOI annually and available to consumers upon request.
Inclusion of Certified Nurse Midwives – To address racial disparities in maternal and infant health, carriers would be required to attest that at least one certified nurse midwife is available within the maximum road travel distance of an enrollee – e.g., five miles in large metro areas, 30 miles in rural areas.
Training Requirements – Carriers’ customer service representatives would be required to complete at least one anti-bias, cultural competency, or similar training prior to the start of plan year 2023 open enrollment, which will begin in November 2022. They would be required to complete such training on an annual basis.
Additionally, carriers would be required to collect network provider and front office staff training information on an annual basis using a standard reporting form created by DOI – which would include, at a minimum, description and duration of training on anti-bias and cultural competency and any certifications. DOI would provide network providers additional time to come into compliance with the training requirement and, notably, would not require carriers to ensure 100 percent of providers and their front office staff have undertaken such training. Instead, carriers would have to ensure at least 50 percent of providers and their office staff have undertaken such training by January 1, 2023, followed by 75 percent by January 1, 2024, and 90 percent by January 1, 2025.
Provider Directories – Carriers would be required to include additional information in Colorado Option provider directories regarding the availability of translation and interpretation services, accessibility-related services for people with disabilities and the procedures for request such services, and information on how to file a complaint related to the accuracy of the provider directory and/or the provider experience. In addition, provider directories (printed and online) would need to include the following details about network providers: providers who are multilingual or employ multilingual front office staff and languages spoken, if the provider offers extended and weekend hours, and the accessibility of the provider office and examination rooms for persons with disabilities.
Language Access – Carriers would be required to ensure language assistance services, including American Sign Language and other communication services for people who are Deaf, Harding of Hearing, and Deafblind, are available at no cost for enrollees when communicating with customer service representatives and network providers. Carriers would be permitted to require enrollees provide “timely” notice of the need for language assistance. DOI elaborates, “Language assistance services are not timely if delay results in the effective denial of the service, benefit, or right at issue.” Additionally, carriers would be required to post taglines in at least the top 15 languages spoken by individuals with limited English proficiency indicating the availability of free language assistance services.
Essential Community Provider Standards
Current network adequacy standards require at least 30 percent of available Essential Community Providers (ECPs) in each plan’s service area participate in the plan’s network. ECPs predominantly provide care to “medically need or medically indigent patients” and charge for services on a sliding scale or waive charges altogether. DOI proposes to increase the minimum ECP standard to 50 percent.
Network Access Plan Requirements
In its network access plan, a carrier offering the Colorado Option would be required to include:
Summary of demographic data collected;
Summary of anti-bias, cultural competency, or similar training completed;
Description of network providers and services to assist enrollees who experience higher rates of health disparities and inequities (e.g., community health workers or promotoras);
Demonstration by service area that each network is no more restrictive than the carrier’s narrowest network; and
An evaluation of carriers’ efforts to create a culturally responsive network. The evaluation must include description of how the carrier has assessed the network is adequate for the anticipated volume of demand for outpatient visits for perinatal, primary care, and behavioral health care as required in the standardized plan.
Action Plan Requirement
A carrier that does not meet the network access plan requirements would be required to submit an action plan that contains the following information:
Description of outreach efforts to providers;
Reasons providers did not or were unable to join the network;
Reasons the carrier was unable to obtain demographic data from providers and/or enrollees; and
Description of complaints from enrollees and how complaints were address.
Lastly, the carrier would be required to include corrective actions, including a set of measurable steps and goals as well as timelines. Enforcement measures include imposing civil monetary penalties, issuing cease and desist orders, and/or suspending or revoking licenses.